Health Psychology Department, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand

Academic Department of Psychological Medicine, Guy's, King's College, and St Thomas's Hospitals School of Medicine and Institute of Psychiatry, London SE5 8AF

Over recent years there has been a steady and important change in the public's perception of the relation between aspects of modern life and health. Now, at the beginning of the 21st century, people's suspicion of modernity has increased to such an extent that it has undermined their view of their own health, increased their worries about environmental causes of poor health, and fostered a migration to complementary medicine. Concerns about the safety of mobile phones, environmental pollution, vaccines, bovine spongiform encephalopathy, genetically modified food, and food in general have led to a heightened awareness of the effect of environmental changes on health. We believe that these concerns about technological change, which have been largely unrecognised by researchers, have important implications for the way patients interact with health services.

This change in public concerns has obvious and more subtle effects. Despite considerable recent research and official inquiries into new technologies such as mobile phones and genetically modified food, public suspicion remains high. In clinical settings patients are reluctant to start medication or to continue it for an extended period for fear of putting “unnatural chemicals” into their body. At the same time the consumption of unproved herbal and alternative “natural” remedies is increasing.1 This anxiety is reflected in the pattern of presentations of psychosomatic illness: the number of illnesses attributed to environmental factors—for example, sick building syndrome, multiple chemical sensitivity, total allergy syndrome, and 20th century disease—has increased.2

The milieu that has fostered this unease with modernity is an increase in the public's fascination with personal health and medicine, as evidenced by the burgeoning of gyms and fitness programmes, and the widespread adoption of a “healthy lifestyle.”3 The media's increased coverage of health topics, in stories on the dangers lurking in ordinary activities such as air travel and vaccination, has raised worries about routine health care and increased people's perception of their vulnerability to new and exotic illnesses. Media stories also tend to misrepresent the dangers of new environmental influences and aspects of modernity, while playing down more mundane causes of ill health, such as the link between tobacco and heart disease.4 This focus of the media on risks with a novelty value fosters the belief that they are far more common than they actually are.

The result of this deluge of information on the supposedly pervasive risks to personal health is that people now feel much more vulnerable. Normal everyday symptoms such as headache and fatigue are now more easily interpreted as signs of disease or ill health. Attributions made by patients about the cause of their illness often involve environmental pollution, and they see the effects of modern life as undermining the effectiveness of their immune system. Not surprisingly, recent research has shown that patients who are the most concerned about the effects of modern life on health are also more likely to complain of symptoms in the previous month, have more functional illness, and be consumers of complementary health care than patients with fewer concerns about modernity.5

Historically, the introduction of new technologies has frequently been accompanied by new complaints, fears, and illnesses, such as railway spine and electric allergy.6 George Beard, the founder of the diagnosis of neurasthenia, ascribed the cause of this disorder to “wireless telegraphy, science, steam power, newspapers and the education of women; in other words modern civilisation.”7 Currently the adoption of new technologies is accelerating and is occurring in a climate of suspicion and mistrust in medical evidence or reassurances.

Distrust of experts is now commonplace, and at its extreme it can merge into the conspiratorial thinking that is part of a modern paranoid style.8 Well publicised crises, most obviously bovine spongiform encephalopathy and foot and mouth disease, have severely dented confidence, although the trend was clear long before. Mismanaged environmental incidents and easily recalled examples of the fallibility of experts, such as in the cases of new variant Creutzfeldt-Jakob disease and thalidomide, add to the fears of the public and undermine its trust in the people and authorities responsible for managing risk. Sadly, trust once lost is difficult to restore.

The internet has brought a new dimension to the spread of worries and health scares. Whereas previous health scares—amalgam fillings, saccharin, and fluoridation of water—were published in the usual media sources, new and unsubstantiated health worries can be instantly transmitted to an internet audience eagerly seeking information on health or to special interest networks, such as illness support groups. A recent US study of hospital outpatients found that 25% of the patients had used the web for medical information in the past year and that 60% planned to do so in the next year.9 Medical scares recently transmitted on the web and through email lists include antiperspirants that cause breast cancer, and the spread of necrotising fasciitis by bananas. We believe it is only a matter of time before a mass psychogenic illness is identified as being spread electronically.

It is difficult to feel optimistic. Despite all the evidence of the extraordinary improvements in public health during the past century, surveys show that we experience more symptoms and feel worse than our ancestors.10 The rapid introduction of new technologies, while improving the quality of life of millions of people, has been accompanied by important adverse effects in the way people make sense of illness and present with health complaints.